Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Emergency Request Letter - SSA COVID In Person Hearings (12-3-21).docx	Supplementary Document	Uploaded 2021-12-03	Repair queued
SSA Emergency Supporting Statement COVID Hearings Questionnaire (12-3-21).docx	Supporting Statement A	Uploaded 2021-12-03	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250661	COVID Screener Questionnaire	Other-Internet Screens	New

ICR Details

OMB Control No:	ICR Reference No: 202112-0960-002
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: SSA	Agency Tracking No:
Title: Social Security Administration (SSA) COVID-19 Symptoms Screener for Hearings
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 12/10/2021
Date Submitted to OIRA: 12/03/2021

table that charts list comparision

	Requested	Previously Approved
Expiration Date	6 Months From Approved
Responses	179,580	0
Time Burden (Hours)	149,650	0
Cost Burden (Dollars)	0	0

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Abstract: Following a temporary pause on in-person service, such as in-person hearings due to the COVID-19 pandemic, SSA will soon restart in-person hearings on a limited basis. When SSA resumes these limited in-person hearings, we will ask participating members of the public to complete a brief COVID-19 symptoms screener questionnaire within 24 hours of their hearings. Background During the recent COVID-19 pandemic, SSA conducted its services almost exclusively online or by telephone, to protect the health of both the public and our employees. We took these measures in accordance with relevant Centers for Disease Control COVID-19 pandemic guidance, and to comply with existing Occupational Safety and Health Act provisions regarding workplace safety. While in-person hearings have not been available since March 2020, claimants or their appointed representatives who wished to appeal a redetermination could choose to participate in an online video hearing or phone hearing instead. We would like to soon resume in-person hearings on a limited-capacity basis. Initially, we plan to keep the number of in person hearings to an average of three separate hearings per hearings office per day, to ensure the continued health and safety of the public and SSA employees. The number of in-person hearings per hearing office may be revised over the course of reentry. Need for Information Collection; Collection Methodology; How Information Will Be Used Because of COVID-19 health and safety considerations, we plan to require all members of the public entering an SSA hearing office to participate in an in-person hearing to complete a brief screener questionnaire designed to identify COVID-19 symptoms. A link to the questionnaire will be provided in the mailed notice of scheduled hearings. People participating in a hearing can complete and submit the questionnaire online within 24 hours before the start of the hearing. If hearings participants do not wish to use the Internet, they can call the hearings office where the hearing is scheduled and complete the questionnaire over the phone. The questionnaire will ask questions relating to personal experience of any COVID symptoms; exposure to someone diagnosed with COVID; or travel by means other than land travel, such as car, bus, ferry, or train. SSA will use the screener responses to determine if the in-person hearings participant is “cleared” or “not cleared” to enter an SSA hearing office. If participants answer “no” to all questions, they are “cleared” to participate. If they answer “yes” to any part of the screener, they will be “not cleared.” Persons who are not cleared may seek to be rescheduled for the next in-person hearing date that at least 14 days after the COVID-19 symptoms first presented, or 14 days after they tested positive for COVID-19. Alternatives to Completing the Information Collection Although completion of the questionnaire will be required for an in-person hearing, it is not required for other modalities of appeals hearings. One may choose an online video hearing or telephone hearing as an alternative to an in-person hearing. Claimants may obtain Social Security payments regardless of the hearing method they choose.

Emergency Justfication: Advocacy groups representing the interests of Social Security claimants and professional organizations from the representative community have requested that we resume in-person hearings. To increase our level of service while maintaining the health and safety of the public and our employees, SSA needs the COVID-19 symptoms screener in place as soon as possible. The length of the standard PRA process would hinder our ability to increase our service. We are requesting emergency clearance with approval to be granted no later than December 12, 2021. We will invite the public to submit comments if they wish to do so. Given the nature of the ICR, it has been conveyed to us that PRA approval does not depend on resolution of or response to public comments. We understand that an emergency PRA approval is effective for six months. If we need to continue using the screener after six months, we will seek full PRA approval, which would include two standard public comment periods.

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Authorizing Statute(s): US Code: 42 USC 405 Name of Law: Social Security Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 68717	12/03/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
COVID Screener Questionnaire

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ICR Summary of Burden

table that charts list of burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	179,580	0	0	179,580	0	0
Annual Time Burden (Hours)	149,650	0	0	149,650	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This new IC increases the public reporting burden. See the chart above for burden figures. The IC does not modify SSA’s existing programs in any way.

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Annual Cost to Federal Government: $110,316

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/03/2021

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